WELCOME

I’m a great woman with a pissed-off vulva. I have “primary vestibulitis”, a subcategory of vulvodynia. Most people are uncomfortable discussing their genital pain in public. Well, I’m not…so, welcome to my blog! There aren’t definitive answers in medical literature to explain the pain cycle of vulvodynia and how to heal it - yet. My hope is that my 20-year obsession to find help for myself will make your experience shorter, easier, and less painful.

Note: recently "vestibulitis" has been renamed to "vestibulodynia".

August 15, 2010

Clitoral Adhesions

Read this whole post for comprehensive information. As I learned more, I wrote updates which go backwards in time. The first post is at the end.

Update:

The smegma returned slightly and she put me on a different steroid called Triamcinolone Acetonide ointment 0.1% and it cleared right up. Please read my 8/15/2010 post for how to use your hands and instruments to loosen up the hood from the clitoris.

Update:
I may have mentioned that I found a vulvar dermatologist at Stanford named Dr. Badger, a lovely woman who reminds me of a blond Mary Poppins, including the phrase, "Oh dear!"

She put me on Desonide 0.05% ointment for an unusually copious presence of smegma. Below is an image of what was extracted by my husband (yes, this is graphic, but I think it is helpful to see). The tweezers were used to lift the smegma off the clitoris once it was expelled (see the "Clitoral Adhesions" entry for my how-to)
.

Per her instructions, I used the Desonide twice a day, morning and night, for 3 weeks. Then I reduced it to once a day for another 3 weeks. It really worked. I healed up and the smegma hasn't returned in the last 5 months). Should it return, she says I can use it again without coming in to see her other than my usual every 3 month check-in.

She also said that the concern that steroids will "melt the skin of your labia" as some doctors have told me is "poppycock" and uninformed. I don't know enough about steroid use on the clitoris so get an opinion on this from your doctor.

I got good suggestions of other steroids to try on my other blog post. I thank you for those suggestions and it was with that knowledge that I was able to go back to my doctor and discuss steroid ointments. Some may ask what the "active ingredient" is in Desonide and the answer is desonide. It is in an ointment of petrolatum and mineral oil.

Update April 26, 2013:
See my post "Clitoral Adhesions Update" for an image of smegma and a topical steroid ointment I used call Desonide that resolved a flare. Thank you to the many commenters that suggested the right topical steroids and made my adhesions leave.

Original Post:
Clitoral adhesions are not given too much medical attention and will likely confound your gynecologist who may have never heard of this. I have gone in to appointments with a drawing of my adhesions (drawn by my not-so-artistic husband). Adhesions develop when your outer clitoral hood fuses (to a lesser or greater extent) with the clitoris. The cause is the continual irritation between to two surfaces. As the body tries to heal itself, the two raw areas begin to heal onto each other. The clitoral hood is supposed to slide back and forth over the clitoris, but in this case, it becomes stuck. Often you develop pockets of sebaceous fluid which normally lubricates the area and allows for slide between the two, but in this case it becomes trapped in inside of the adhesions and becomes a further irritant. When it can't be discharged, it dries out and goes from an oil-like lubricant to smegma. You can see this smegma trapped inside the adhesions. Smegma is white and hard.

The treatment, invented by me and my husband is this:

I spread my labia and clitoral hood apart so that he can see the area;

He uses a black head extractor with a soft point on the end shown here. If you wince, fine. If you cry, stop as you are just damaging yourself at this point.

He may use a little oil - baby, olive, whatever - or sometimes goes dry;

He slides from top to down along the seam prodding it open (again, I am holding the clitoral hood and the clitoris as open as possible so that he can see);

I then try to put my fingers on each side of the crevice and pull it apart gently (this alternates with the other approach);

It is importantly to work on this a bit and then leave it for a a few days before you come back to do some more loosening as this process inflames the skin and that is what you do not want to happen.

Yes, this hurts. We once had to work on one individual adhesion for 4 years (it had probably been there for a very long time) to get it open and it recently returned. This time it took only a few weeks to open. The important thing is to catch it before it starts to fuse again.

Open the clitoral hood and clitoris in the shower and gently pull the two sides apart once every 2-4 weeks (daily will just irritate you and make the skin more raw). I gently, gently wash with Cetaphil. No scrubbing. It is more just like how women apply face wash in commercials with the light touch, moving in slow circles for a brief moment.

After a session, slather on some ointment like Lidocaine 5% or Vaseline to give the skin a barrier protectant.

Doctors have said to just keep going at it like we have been. And that they don't have a better solution. And they compliment my husband on his fine work.

37 comments:

Hi, I just found your description of clitoral adhesions. I am certain that I have them also... I can see that the hood has become stuck to the glans of my clitoris, and I have had, over the years, kernels of dry smegma build up and finally expel themselves, with a bit of tugging and a hand held shower massage to ease them along. Well, lately I have been having pain associated with the adhesions... this is a new-to-me experience and decidedly undesirable!! I'm curious if your treatment method (for which I applaud you!!) has relieved any pain you may have had related to your own clitoral adhesions. Thanks for any comments you may have on this subject.

Sorry for such a late response. Yes, I have been able to eliminate my clitoral adhesions almost completely. The critical steps for me have been being much more gentle in my washing (see Cetaphil post), wearing a vaseline type cream - in my case Lidocaine 5% - why not reduce the pain as long as I am wearing ointment?, and having my husband do regular checks (once every 6 weeks?) If I have adhesions and smegma, he then tries to open the adhesions and remove the hard balls of smegma. Over time, he has learned to stop early before I am in tears and not leave me raw in one session and then to go back and work on it a few days later when I have had some time to heal. I also help by pulling the two pieces of skin away from each other which gives him better access and sometimes actually opens an adhesion. I wouldn't know what to do without my husband because I would be difficult to do on my own...maybe I would see my gynecologist or vulvar physical therapist for help? Something I don't do because I don't have a bathtub is to soak in warm water. I think doing this would be very helpful. Of all my vulvar problems, the adhesions have gone from on of the most intractable problems and source of daily pain to one that barely is a problem. Mind, I still have adhesions, but they are much smaller and don't build up smegma at the same rate. So, keep trying and eventually you will be able to manage this. At the same time, it took me a long time to get this under control so know that you just need to persist and I believe you will be much better. Damn, it hurts. Right?

Wow, this has really helped me. I need to find a gyn who specializes in this because I am just learning and realizing I have this problem. I only realize it because I wanted to get a clitoral hood piercing, and I couldn't pull back the hood to get it done. As a teen I had large amounts of Smegma come from around my clitoral area and never knew what it was and I was too embarrassed to say anything. Now the two are completely fused so I have some work to do. Thanks for your posting.

Since most gynecologists seem to ignore that women can actually have phimosis, I would like to share my experience and research for anyone who may face this. As the other anon commented, the cream treatment for penile phimosis can be really effective (with little to no pain, though the area may get too sensitive after you massage it by pushing the hood back). I bought a cream in Brazil called Postec (over-the-counter), which consists of betamethasone and hyaluronidase (25 USD). In less than a week you can already notice a huge difference. The treatment is recommended for 3 weeks, to be applied twice a day. If you just use the cream without massaging, the treatment may not work. The instructions on the cream tell you not to apply much pressure on the first week of the treatment, and that after the 7th day you can start increasing the pressure). Simply pushing the skin back and forth for around 2 minutes every time I applied the cream has released my adhesions in only 3 weeks.

Well, I'm so happy to read all this...I'm 41 and I always had orgasm problems and I think I just found what my problem is! It took me 45 minutes of research on google to find this page about that subject!! I realized that I could have a clitoral adhesion because of my daughter...ok let me tell the story... She started to have pain when I washed her clitoris and found out that the skin was starting to stick to her clitoris. I have a son also and I worked many years of pulling back his prepuce to avoid adherences, as my pediatric doctor (and everybody!) told me. (I speack french, not sure if it's the right words). I told myself why this clitoris that looks so much like a penis should not be liberate too? So I learn today that girls don't get education about the clitoris, it's so taboo! so I will try to get that cream and start the treatment on me and I will talk to my daughter about taking care of her clitoris so she doesn't frustrate like me in her sexual life! Thank you so much for the information you shared.

I am glad this helped. It makes me feel good that you might find direction on treatment. It sounds like your family is prone to dermatitis (skin irritation). Maybe go see an allergy doctor and get tested?

Orgasm is impossible for me if my clitoral hood is stuck. My clitoris just hurts. Nothing is sexy about that.

Thank you for posting information about this personal subject. Now I have new hope that soon I will be able to enjoy "relations" again. Certainly, if we were men...this would be headline news and an agressive treatment would be available.

We've been attempting to free my wife's adhesions for about 6 years now using a q-tip and strong vitamin E oil, and it started to work but really slowly. Cleans up the smegma easily, but not as well as baby oil. Baby oil literally melts it away, but its not as good for trying to separate the glans from the hood. This post and comments got me to look for betamethasone and she got it, and wow, its working like gang busters! Twice a day for the last 3 weeks and the hood has separated and moved back almost 2mm on one side, 2mm or more on the top and the left side, which is the most stuck, is finally freeing up, it has never ever moved. Her glans is almost completely free and we are just too excited!!! Thanks for the info ladies, you've brought our multi year journal to an almost end, another week or a little more and we're "free"

Well, we went through 6 weeks of cream applications, under the hood and using a cosmetic q-tip to rub it slightly hard against the adhesion point where the foreskin meets the glans. It worked like a charm!!!! Her glans is completely exposed when the foreskin is pulled back, and she is very, very happy now :) There was slight irritation and swelling from the cream during the last week, but we got through it and she was on Vitamin E oil twice a day for a few days, she's all back to normal. I hope all you women here can get relief for your problems and use our example as a success story, it can be done!

I have been suffering from clitoral pain for a while now. I just recently found a doctor who told me I have clitoral adhesions. He has me on an estrogen cream. I use it daily and try and pull the hood back as far as I can and massage the cream into the area. I have been very sore since I started this but that is to be expected. My question is, did your wife get the betamethasone prescribed to her by a doctor? And was a cream, ointment...? Thank you for your help! I'm glad you are free and I hope I can be soon too!

It was betamethasone and she got it online. It worked good, we couldn't finish up on the right side, it was still stuck a little bit (didn't really notice until a few weeks after the treatments). But we didn't stick to it or do like maintenance every few weeks or so and she's starting to revert back to adhesions!! Going to start it up for about 2 weeks again next month, will update here with results.

That is so awesome! I am delighted. I tried a few other topicals and had success with Triamcinolone Acetonide Ointment USP, 0.1% so that is another one to put out there. It took care of the adhesions, but not the vulvar pain.

Hey. Good work on putting this up. I started reading about these problems on the net because I was also dissatisfied with the way wy clit did not show much. Never had much problems coming, I guess I was lucky with patient and skilled b-friends. But I started thinking I could do better. Can't believe no gynaecologist ever looked at my clitoris !!! Thank god people like you share their experience. Keep spreading the knowledge to beat the ignorance of the medical profession.Anyway, I have started stretching, and seen already a few improvements. Will get a cream and see how it goes.

Wow - I have just realized that this is my problem too! For about 6 years I've had trouble with my clitoris being irritated from time to time and being sore to touch, and small tiny beads of smegma. And the best news for me is I've just realized I have the Beta cream from my sons phimosis treatment! So I'm going to start treatment right now. WIll let you know how I get on.

This discussion is exactly what I was looking for!My wife's clitoris is also stuck inside the hood in the ways described. When we were first having sex 26 years ago I tried to explain this to her and I was surprised that she was not aware of this? I had sex wit a few women before we met and I had seen many clits! Most were stuck but I didn't know any different until I met a women who wen she got aroused her clitoris would pop out and get hard like a tiny penis, it was so exciting for me and I had to learn to be very gentle when I was licking or sucking. It was amazing to me that this was what a healthy clitoris was supposed to look like! Unfortunately I think from personal experience most women have clitoral adhesion, ad they don't know about it because it has probably been this way since very early in their lives.And it would seem that Gynaecologists don't care or don't want to have to deal with it or to mention this because they don't think it's important!!!I would really like to help my wife to understand that this is not normal, and I would love to be able to see her clit free to pop out and get the attention it deserves, but I don't know how to explain this in a way that will allow her to let me try and fix this?Any ideas from anyone how I should broach this topic?I don't want her to feel that this is bad, or that her pussy is less than perfect!FYI She does have orgasms but she does have to really work at them!

I never answered your question about how to talk to her. Perhaps you have (I hope) and can offer advice to others. You obviously care a lot to even be looking for this on the web. If she doesn't know she has a problem and is not complaining, it could be devastating 1. to her sexual self image, esp. because you have compared her to others and know "something is wrong" and then 2. because of the pain that releasing the hood entails. That itself is traumatizing and the orgasms or any pleasure seeking sexuality may go away while the clitoris is healing, and 3. it will take a very long time during which your wife and your sex life may be undermined. I would only address it if she mentions something negative about her vulva or sees the smegma itself. Or perhaps you can call her doctor and mention this as a concern for her next physical. I hope you have a doctor who will take the time to look and advise.

I had a vaginal exam today and the practitioner said that the hood of my clitoris may be stuck but she didn't use the term *adhesions?* I have had very few orgasms in our 31 years of marriage and think this could be my problem. I am unclear from the description above as to how to release it. Can't believe I've lived this many years not knowing this!!!

The simplest way to think about it is that to release the two, you have to pull the clitoral hood away from the clitoris itself. What has happened is the two have fused because of irritation/inflammation. And the fusion irritates the skin all the more. So you need to soften it up with steroidal ointment that provides lubrication and will also help with inflammation, work on pulling the two apart with your fingers, and then prying it open (gently) with a q-tip or the tool I use. Lots of different strategies are given above by commenters with a number of different ointments. It will probably take you a very long time (years). I was surprised to see what my clitoris "actually looked like" once I got it unadhered. If you want to ask a more specific question after test driving and seeing where it goes wrong, I'll try to answer.

I thought giving you the same information written by another person might be helpful. I pulled this off of yahoo.answers and is a very good descriptor of what's going on. The author is anonymous so I cannot credit her:

The hood of your clitoris naturally produces sebum, a fluid that lubricates your clitoris and allows the hood to move smoothly over the clitoris. It can build up though and become smegma, which has a white, cheese consistency. It's painful because now instead of fluid you have harder stuff rubbing against your clitoris and irritating it. The best way to prevent it is to pull back the hood of your clitoris and clean it everyday (but only with water, no soap) to keep it from building up. I had this problem myself a while back so I know how it feels!

The person below me doesn't know what he's talking about. Smegma can easily build up in clitorises. Here's some more sources:

I've come to your page previously but not since the steroid cream update. I actually have both of those creams for eczema. The desonide doesn't work as well as the triamcinolone for eczema so I doubt it's usefulness at all. Ha! So can you tell me did you just put the cream in twice a day or did you have to really work at the already set adhesions? Or did they loosen gradually on their own?

I agree that the triamcinolone is better. I did have to "work" as the ointment was not enough. I think I was so stuck, it couldn't penetrate the adhesions. Take a look at my December 10 comment for the details. I would generally work on pulling it apart at night before bed with my husband's help. And then give the clitoris a few days break to let the inflammation go down before going back again. You can also try doing this when you are in the shower and you can try doing this when you are sitting on the toilet - only because it gives a better vantage point then sitting on a normal chair, on the bed, or on the floor. Both are not as good as having someone help you, however. As it becomes slightly less stuck, the ointment will be able to get into the adhesions and help.

Now that they are gone, I gently pull the clitoral hood skin from the clitoris everyday when I am in the shower and use the Triamcinolone Acetonide ointment as needed. When the adhesions start up again, I can be decently aggressive with my fingers and pull it apart.

I've suffered with clitoral adhesions for years. My Ob-Gyn prescribed estrogen cream in the past, but it hasn't helped. Generally one side or the other, and occasionally both sides of my clitoris would have a split and bleed. I've never been able to free either side. While researching info, I came across your blog at just the right time.. as my yearly exam was coming up. I spoke with my Dr. and she prescribed the Triamcinolone cream. I just started using it.I have very little if any smegma, because there's no place for it. The area around my clitoris literally looks like it's glued shut. When you 1st started your technique, could you see smegma? Or was it "buried" and started to show up as the hood started to free up? Thank you for posting this. I know it's a private matter, and not the easiest thing to discuss. The pain I have from the adhesions as well as Vulvar Vestibulitis, Interstitial Cystitis, and Pudendal Neuralgia is often unbearable.I'm just grateful to have found your blog, and now have something that may work to clear up some of my pelvic pain.

Yes, the smegma was originally "buried", as you said. All I knew was that it seemed odd that my clitoral hood was attached to the clitoris. The smegma only became visible after I was able to release a tiny area and could see in.

Having the triple combo of vestibulitis, I.C., and pudendal neuralgia must be horrid. I can't imagine the pain of the I.C., but know the other two suck. Have you had cortisone injections? Are you seeing the right P.T. for the pudendal neuralgia? Mine has gotten better (not perfect, as I am writing this in low-level pain) with the right physical therapy exercises. My current physical therapist does no internal work, but is treating the mechanical problems of my whole body.

I found her from seeing a good physiatrist (someone who specializes in chronic pain) and got this recommendation. After seeing 7 previous P.T.s this one seems to be giving me exercises that are working.

I also want to note that pain is a loop and I may not have been "ready" before to start healing the neuralgia when the other health problems I face were bad: a mood disorder, thyroid, arthritis, compressed nerve in my back that radiated pain down my left leg.

Thank you so much for the quick reply! You and I suffer from many similar issues. I think my depression and anxiety are also a vicious loop. I'm in pain which is depressing, then the depression magnifies the pain...

I actually found a wonderful PT who specializes in pelvic floor issues. My degree is in OT, but finding a pelvic floor PT was a challenge! When I finally found there was 1, and she wasn't 300+ miles away, I was thrilled!

I saw her for over a year, she did external and internal pelvic work, along with working to get my hips back in alignment and keep them in alignment. I haven't seen her I a while, but I have several exercises and techniques from her that I still do in my home program.I've not had cortisone shots. I did go once a week for 16 weeks to my urologist's office. There they put a catheter in, instilled a cocktail of meds to see if it would help my IC. I had to try and hold the med in my bladder for at least 1 hour. All it did was cause more pain.I tried Elmiron, only med they have to try and manage the IC. But it can cause liver problems, and of course it did in me, so no more Elmiron.I also have Lupus with secondary Sjogrens, migraines, and a "fun" stomach which makes trying to eat a balanced diet mostly impossible.

On a happy note, I'm blessed to have an amazing hubby who will help me any way he can. When I read where your hubby helps you, it reminded me so much of my hubby and me.

I'm only on day 3 of the steroid cream, sure hoping it works. My Dr has also prescribed Lidocaine gel, at least it numbs up the area somewhat if it's hurting too much.

Hello! I have just found out I have a clitoral adhesion. I think it could have been like this for several years, when I was in the shower I tried to pull back the hood, and I cant find my clit at all... I tried to find it but only smegma and a little bit of blood came out. I do not know what to do, Im only 16 and I do not want to go to a GYN... Do you have any tips on what I can do, except what you have written here? - Worried girl

First, thank you for writing and being an advocate for yourself. Something I have asked myself is how someone without the resources of a doctor or a partner to pull the skin back improves. And, to give you assurance, your age may help this go faster.

I'm curious as you why you are reluctant to see a doctor? Embarrassment? Health insurance? Thoughts: 1. a gyn or internist would be able to write up the prescription topicals I mentioned here. These topicals are what ultimately helped me after several DIY methods. This is the only way to get the medication. 2. you could try the olive oil, crisco, petroleum jelly to soften it up and then pull gently every day (also, a dull tipped pair of tweezers that you can run along the adhesions might help if you are doing this on yourself), 3. it will really really be easier if you have a friend/boyfriend/parent do some tugging. This may feel impossible to you. I haven't used a mirror to do this. I'll be curious as to how that works. The good news is...you probably haven't had this for more than 3 years so your chance at opening it up is better than you might assume.

Thank you for replying so fast! I will try to do it myself, but if it doesnt work I just have to try to convince myself to go to a doctor, and why I wont go is because of embarresment. Thank you so much for your help.

Any advice for this younger person who wrote the above comment? 16 years old, 3 years adhered with quite a bit of work to do, won't see a doctor, and possibly needing to work on this by herself rather than with a partner. Ideas? I'd like to give her as much help as possible.

We've learned that you should not wash your clitoris with soap, especially don't let soap get up under the foreskin if you can help it, it dries out the sebum and takes away all the natural lubricant. We read that soap can create adhesions. Since reading my wife does not use soap anymore and is much better off. Also, don't forget to try Vitamin E oil, it really is a wonder! We've found that baby oil literally melts smegma, it makes it go away quick and completely, but you want to follow up with vitamin E oil after that. The young girl should try these things, might be an easy start?

What a great blog! Thank you for being so open about this intimate and surprisingly common problem. There is also stigma with the adhesion topic, because it is sometimes portrayed as due to a lack of hygiene, when in fact, it seems to be due to ignorance (about clitoris maintenance, not using soap and so on). How can we be so ignorant about our clitoris, it baffles me.

Starting about nine years ago, I started to consult doctors because my clitoris was inflamed. One even cauterized it with liquid nitrogen to try to help - how I let that happen, I don't know today, but he did. He had no clue what was going on, but he was a "specialist" and the fourth doctor I was seeing. It took YEARS to find an ob-gen who suggested adhesions as the culprit for my pain and intermittent swelling. In parallel, I even went to a psy to try to deal with my lack of desire... It's talking with her that I clicked: "of course I don't feel like it, I'm in pain!!!". Again, hindsight is 20-20... If it hurts overtime you have sex, it does kill your desire. Duh! I guess preferred to blame myself than to acknowledge I had a physical problem - but that's a topic for another blog. ;)

So, I looked up "clitoral adhesion" online I developed a technique similar to yours, slowly "working" to pull back the hood. I used the Clobatesol cream the ob-gyn prescribed, but I am not sure if it helped. I never saw smegma, but it was probably there in very small quantity. I would pull on the hood sideways (quite hard) until a new red part of the clitoris is exposed, a little bit at-a-time, in the shower. I used Aveeno oil to help lubricate the area. It burns quite a bit on contact, but it seems to help with the healing and the burning sensation goes away quickly. I used special q-tips (very pointed ones with a hard tip, probably for manicures) that I found in a beauty-supply store, and proceeded pretty much as you described, inserting the tip between the clitoris and the hood, slowly moving up and down, opening the gap. I do this myself, so it is not easy. I can see the advantage of enlisting the help of a partner - I am not comfortable with this. Hey, I'm improving my flexibility! LOL I could use a third hand though.

Long story endless, my vulva started to tingle recently when I was sitting down. It took me a few days to remember the feeling and the cause. Looking in the shower today, the hood was quite stuck. I started pulling to free it. The posts on this blog also made me realize that, although I freed my clitoris before, I probably never freed it completely and this time, I will persevere instead of stopping when it feel somewhat ok.

Thanx a million! It's nice to not be alone anymore and to know there is hope for so many women.